Re: Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: A randomized, controlled, single blind trial

摘要

Experts' summary: Nyarangi-Dix et al., in their randomized controlled single-blind trial, analyzed a cohort of 208 men who underwent either open or robot-assisted radical prostatectomy (RP) for prostate cancer. Patients were preoperatively randomized to complete bladder neck preservation (cBNP; n = 95) or no bladder neck preservation (BNP; n = 104). To avoid bias due to failed BNP, they excluded nine men from the first group for the statistical analyses. The BNP technique consisted of a complete dissection and preservation of the bladder neck and proximal urethra, regardless of the surgical procedure adopted. The aim of their study was to investigate the influence of the bladder neck and proximal urethral preservation on urinary continence, quality of life (QpL), and status of surgical margins after RP. At 12 mo of follow-up, the authors found a statistically significant decrease of overall mean urine loss at 0,3,6 and 12 mo in the cBNP group compared with the control group (p < 0.001); similar results were demonstrated in terms of overall objective continence rates and mean number of daily used pads. A statistically significant improvement of QoL was found in the cBNP group (p < 0.001). In regard to oncologic outcomes, the rate of positive surgical margins (PSMs) was 13.6%, with no statistically significant difference between the two randomized groups (p = 0.65), and only 2% of PSMs were found at the bladder neck. The authors concluded that cBNP was associated with significantly higher early and overall continence rates and better QpL outcomes, without compromising optimal cancer resection, thus recommending cBPN during RP whenever possible.